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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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The use of dynamic O-(2-18F-fluoroethyl)-L-tyrosine PET in the diagnosis of patients with progressive and recurrent glioma

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  • Marion Rapp - Department of Neurosurgery, University of Düsseldorf, Düsseldorf
  • Gabriele Stoffels - Institute of Neuroscience and Medicine, Research Center Jülich, Jülich
  • Hosai Sadat - Department of Neurosurgery, University of Düsseldorf, Düsseldorf
  • Michael Sabel - Department of Neurosurgery, University of Düsseldorf, Düsseldorf
  • Karl-Josef Langen - Institute of Neuroscience and Medicine, Research Center Jülich, Jülich; Department of Nuclear Medicine, University of Aachen, Aachen
  • Norbert Galldiks - Institute of Neuroscience and Medicine, Research Center Jülich, Jülich; Department of Neurology, University of Cologne, Cologne, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.02.02

doi: 10.3205/14dgnc119, urn:nbn:de:0183-14dgnc1193

Published: May 13, 2014

© 2014 Rapp et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Since a number of studies have indicated that dynamic O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) PET may be helpful for the distinction between high- and low-grade glioma, we evaluated the diagnostic performance of dynamic 18F-FET PET in patients with progressive/recurrent glioma.

Method: 106 dynamic 18F-FET PET and conventional MRI scans of 100 glioma patients (primary WHO grading: grade II, n=55; grade III, n=19; grade IV, n=26) (mean age, 50±14 y) were retrospectively analyzed. The patients were consecutively sent with MRI findings suggestive of tumor progression/recurrence (i.e., based on RANO criteria) (91%) or inconclusive MRI findings (9%) to rule out tumor progression/recurrence. Maximum and mean tumor/brain ratios (TBRmax, TBRmean) of 18F-FET uptake were determined (20-40 min post injection). Time-activity curves (TAC) of 18F-FET uptake in the tumors were generated and the time-to-peak (TTP) was calculated. Furthermore, TACs of each lesion were assigned to one of the following curve patterns: (I) constantly increasing 18F-FET-uptake without identifiable peak uptake; (II) 18F-FET-uptake peaking at a midway point (> 20-40 min) followed by a plateau; and (III) 18F-FET-uptake peaking early (≤ 20 min) followed by a constant descent. Diagnoses were confirmed histologically (93%) or by clinical follow-up (7%). Diagnostic accuracy of PET and MR imaging parameters for the detection of tumor progression/recurrence was evaluated by receiver-operating-characteristic (ROC) analyses.

Results: MRI and 18F-FET PET findings were concordant in 81%, discordant findings could be observed in 19%. The highest accuracy (95%) to diagnose tumor progression/recurrence was obtained when both a TBRmax ≥ 2.8 and TAC pattern II or III were present (AUC, 0.966±0.02; sensitivity, 96%; specificity, 91%; P < 0.001). In contrast, the accuracy to diagnose tumor progression/recurrence using conventional MRI according to the RANO criteria was 82%.

Conclusions: Dynamic 18F-FET PET may contribute significantly to the management of patients with tumor progression/recurrence.